Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature

2021 ◽  
Vol 29 (1) ◽  
pp. 185-196
Author(s):  
Zejian Zhang ◽  
Dong Chen ◽  
Ling Deng ◽  
Wei Li ◽  
Xisheng Wang ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Large Diameter ◽  
Renal Cysts ◽  
Ureteral Injury ◽  
Ureteral Stent ◽  
Lumbar Region ◽  
Retroperitoneal Laparoscopy ◽  
Iatrogenic Ureteral Injury

PURPOSE: To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. PATIENTS AND METHODS: Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. RESULTS: In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 –44 ml/min). CONCLUSIONS: For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.

scholarly journals Parenchymal mucinous cystadenoma of the kidney: a case report and literature review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mahmoudreza Kalantari ◽  
Shakiba Kalantari ◽  
Mahdi Mottaghi ◽  
Atena Aghaee ◽  
Salman Soltani ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Left Kidney ◽  
Previous History ◽  
Mucinous Cystadenoma ◽  
Single Layer ◽  
Renal Cysts ◽  
Cystic Mass ◽  
Flank Pain ◽  
History Of

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.

scholarly journals A Clinical Control Study on the Retroperitoneal Laparoscopy for Unilateral Simple Renal Cyst Decortication in Day Surgery Mode

2020 ◽  
Author(s):  
Xiao-Liang Zhu ◽  
Song-Jiang Wu ◽  
Yasmeen Bano ◽  
Wen-Li Liu ◽  
Ming-Hui jiang ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Previous History ◽  
Operation Time ◽  
Renal Cysts ◽  
Day Surgery ◽  
Simple Renal Cyst ◽  
Inpatient Ward ◽  
Medical Environment ◽  
History Of ◽  
Retroperitoneal Laparoscopy

Abstract Background: Under the constraints of the increasingly tight medical environment and cost, day surgery mode has become a favorable trend and attracts attention from clinicians. Currently, there are no standards or procedures on the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in day surgery mode. We attempted to investigate the feasibility and safety criteria of unilateral simple renal cyst decortication by retroperitoneal laparoscopy in the day surgery ward and to compare the advantages and the disadvantages with conventional inpatient ward mode.Methods: A total of 41 patients with unilateral simple renal cysts meeting surgical indications were enrolled in this study. To see whether patients in the day group could successfully complete the procedure and be admitted and discharged within 24 hours and to summarize the advantages and the advantages. The indexes of the operation time, time of hospitalization, postoperative complication rate, total costs of hospitalization and other indicators were compared between the two groups.Results: 41 cases of unilateral simple renal cyst decortication were completed successfully. Patients were followed up 10-12 months after surgery. The results of time of hospitalization, total costs of hospitalization and time of postoperative removal of drainage tube were statistically significant between the two groups of the day ward group and the inpatient ward group (P <0.05). Conclusions: We concluded the retroperitoneal laparoscopy for unilateral simple renal cyst decortication in patients with unilateral renal cysts was safe and feasible in day surgery mode under certain indicative criteria. The criteria included patients’ age between 40 and 80 years, no previous history of abdominal surgery, CT showing a unilateral renal cyst (Bosniak I or II), preoperative ASA assessment was I or II, no contraindications to surgery or anesthesia, postoperative team management and discharge assessment. Advantage of reducing time of hospitalization and total medical cost may relieve the situation of the shortage of medical resources.

scholarly journals Long-term outcome after flexible ureteroscopy with holmium laser for simultaneous treatment of a single renal cyst and ipsilateral renal stones

2019 ◽  
Vol 47 (8) ◽  
pp. 3601-3612 ◽  
Author(s):  
Zhu Zewu ◽  
Chen Hequn ◽  
Cui Yu ◽  
Li Yang ◽  
Yang Zhongqing ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Intraoperative Complications ◽  
Renal Cysts ◽  
Holmium Laser ◽  
Flexible Ureteroscopy ◽  
Simultaneous Treatment ◽  
Period Range ◽  
Term Outcome ◽  
Long Term Outcome

Objective To assess the long-term outcome of simultaneous treatment of a single renal cyst and ipsilateral stones with transurethral flexible ureteroscopy (FURS) lithotripsy and internal cyst drainage. Methods Patients who underwent simultaneous treatment with FURS lithotripsy and internal cyst drainage in our institution between July 2014 and September 2017 were enrolled. The cyst wall was identified endoscopically and a 1–3-cm window was created in the wall using a holmium laser. The proximal end of a double-J stent was placed in the cystic cavity to facilitate internal drainage. Results Thirteen patients underwent simultaneous treatment. No intraoperative complications with Clavien grading score >2 were noted in any patients. Mean stone burden and cyst diameter were 1.6 (range: 0.9–2.5) cm and 5.8 (range: 3.0–7.1) cm, respectively. Stone-free rates after single and complementary procedures were 84.6% and 92.3%, respectively. During the mean 33.1-month follow-up period (range: 17–54 months), seven patients (53.8%) achieved full resolution of renal cysts, five patients (38.5%) maintained >50% size reduction, and one patient (7.6%) experienced recurrence at 18 months postoperatively. Conclusions FURS with a holmium laser may constitute a safe and effective alternative procedure for simultaneous treatment of a single renal cyst and ipsilateral stones.

Renal Cysts in Living Donor Kidney Transplantation: Long-Term Follow-up in 25 Patients

2009 ◽  
Vol 41 (10) ◽  
pp. 4047-4051 ◽  
Author(s):  
D. Grotemeyer ◽  
A. Voiculescu ◽  
F. Iskandar ◽  
M. Voshege ◽  
D. Blondin ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Renal Cysts ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Long Term Follow Up ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

Large Diameter Advanta V12 Covered Stent Trial for Coarctation of the Aorta: COARC Study

2021 ◽  
Author(s):  
Elchanan Bruckheimer ◽  
Einat Birk ◽  
Lee Benson ◽  
Gianfranco Butera ◽  
Robin Martin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pressure Gradient ◽  
Doppler Echocardiography ◽  
Stent Implantation ◽  
Large Diameter ◽  
Coarctation Of The Aorta ◽  
Covered Stent ◽  
Unique Identifier

Background: Covered stent implantation for treatment of coarctation of the aorta (CoA) is effective and can prevent aortic wall injury. Prospective studies with long-term follow-up, including imaging, are lacking. We report the acute and long-term outcomes for use of the Large Diameter Advanta V12 covered stent for treatment of native and recurrent CoA. Methods: A prospective, multicenter, nonrandomized study was performed including 70 patients (43 male), median age 17 years, median weight 57.4 kg with CoA who underwent implantation of the Large Diameter Advanta V12 covered stent. Annual follow-up for 5 years included Doppler echocardiography to calculate diastolic velocity: systolic velocity ratio. Results: CoA diameter increased from 5.6±3.6 to 14.9±3.9 mm ( P <0.0001) and the pressure gradient decreased from 35.8±16.2 to 5.6±7.9 mm Hg ( P <0.0001). Preimplantation diastolic velocity:systolic velocity of 0.6±0.16 dropped to 0.34±0.13 ( P <0.0001) and was maintained at 5 years. Computed tomography angiograms at 12 months postimplantation demonstrated the stent:transverse arch diameter to be similar, 0.91±0.09 to postprocedure 0.86±0.14. Major adverse vascular events at 30 days and 12 months were 1.4% and 4.3%, respectively. Significant adverse events included three patients who required stent implantation to treat infolding. There were no mortalities. Conclusions: The Large Diameter Advanta V12 covered stent is safe and effective for the treatment of CoA with an immediate and sustained reduction of the pressure gradient over 12 months and 5 years as assessed by preimplantation and postimplantation Doppler echocardiography and 12-month computed tomography angiography. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00978952. URL: http://www.anzctr.org.au ; Unique identifier: ACTRN12612000013864.

scholarly journals Intraperitoneal marsupialization of a giant para-pelvic renal cyst: A case report

2014 ◽  
Vol 8 (11-12) ◽  
pp. 872 ◽  
Author(s):  
Abdul Rehman ◽  
Muhammad Awais ◽  
Noor Ul-Ain Baloch ◽  
Hammad M Ather
Keyword(s):  
Case Report ◽  
Renal Cyst ◽  
Renal Cysts ◽  
Young Female ◽  
Open Approach ◽  
Cystic Lesions ◽  
Type Ii ◽  
Technical Challenge ◽  
Feasible Option

Simple renal cysts are among the most common cystic lesions of the kidney. Renal cysts most often remain asymptomatic, but rarely these cysts may become huge in size and result in significant symptoms. Giant renal cysts present a technical challenge in terms of surgical management. Although laparoscopic procedures have been performed successfully at experienced centres, intraperitoneal marsupialization via open approach may be a feasible option at less experienced centres. We report a case of a young female with a giant (24 × 18 cm) renal cyst of Bosniak type-II variety. De-roofing and intraperitoneal marsupialization of the cyst was performed. At the 1-year follow-up, she was asymptomatic, with no residual cyst.

Management of Plasmacytomas of the Spine

Neurosurgery ◽  
1983 ◽  
Vol 13 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Christopher M. Loftus ◽  
Christopher B. Michelsen ◽  
Frederick Rapoport ◽  
J. Lobo Antunes
Keyword(s):  
Symptomatic Relief ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Medical Work ◽  
Systemic Involvement ◽  
Neurological Improvement ◽  
Definition Of ◽  
Work Up

Abstract Epidural plasmacytoma often reflects systemic myelomatous involvement and usually has a poor prognosis. The isolated spinal plasmacytoma, however, is a lesion with the potential for long term remission or even cure in some cases. We report six patients with isolated plasmacytoma of the low thoracic or lumbar region, all of whom presented with pain and minimal neurological deficits. Our approach to such cases included a complete medical work-up and radiographic definition of the lesion with a bone scan, a skeletal survey, myelography, computed tomography, and, in some instances, spinal angiography. All of these patients underwent laminectomy and spinal fusion with autologous bone and harrington rods. There was no morbidity associated with the procedure, which was designed to prevent possible collapse during subsequent radiotherapy or chemotherapy, with its attendant potential for neurological catastrophe. Several patients have developed systemic involvement necessitating chemotherapy, but in follow-up extending now to 4 years all patients remain ambulatory and pain-free. We are encouraged by the potential for symptomatic relief and neurological improvement of patients with isolated spinal plasmacytomas who are treated with an aggressive medical and surgical approach.

scholarly journals Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS)

2021 ◽  
Vol 09 (06) ◽  
pp. E895-E900
Author(s):  
Zain A. Sobani ◽  
Swathi Paleti ◽  
Tarun Rustagi
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Large Diameter ◽  
Outlet Obstruction ◽  
Jejunal Ulcer ◽  
Metal Stent ◽  
Ultrasound Guided ◽  
Regular Diet

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a 15-mm lumen apposing metal stent (LAMS) has emerged as a viable alternative to surgical gastrojejunostomy for management of gastric outlet obstruction (GOO). However, given the size of the anastomosis created with a 15-mm LAMS, long-term luminal patency and clinical outcomes may be suboptimal. The aim of this study was to evaluate the technical feasibility, efficacy, and safety of EUS-GE with a large-diameter (20 mm) LAMS (LLAMS). Patients and methods A retrospective analysis of a prospectively maintained database of all patients undergoing EUS-GE with LLAMS between December 1, 2018 and September 30, 2020 was performed. All EUS-GEs were performed using a cautery-enhanced LLAMS. Results Thirty-three patients were referred for endoscopic management of GOO. Two patients were excluded due to a lack of an adequate window for EUS-GE. The remaining 31 patients (93.94 %) (mean age: 61.35 ± 16.52 years; 54.84 % males) underwent EUS-GE using LLAMS for malignant (n = 23) and benign (n = 8) GOO. Technical success was achieved in all patients (100 %) with attempted EUS-GE. Complete clinical success (tolerance of regular diet) was achieved in 93.55 % of patients (n = 29). Two patients (6.45 %) had partial clinical success and died of unrelated causes prior to advancing diet beyond full liquids. Overall mean follow-up was 140.84 ± 160.41 days (median 70, range 4–590). All stents remained patent with no evidence of recurrent GOO symptoms. One patient (3.23 %) developed an asymptomatic clean-based jejunal ulcer on 3-month follow-up endoscopy. Conclusions EUS-GE with LLAMS is a technically feasible, effective and safe option for patients with GOO allowing for tolerability of regular diet. Future prospective, ideally randomized studies comparing long-term outcomes of EUS-GE with 20- and 15-mm LAMS are required.

Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 425-429 ◽  
Author(s):  
Menno T de Bruijn ◽  
Erik Tournoij ◽  
Daniel AF van den Heuvel ◽  
Debbie de Vries-Werson ◽  
Jan Wille ◽  
...  
Keyword(s):  
Large Diameter ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Special Focus ◽  
Technical Success ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Different Types

Purpose To describe an off-the-shelf method for the treatment of abdominal aortic aneurysms with hostile (large, >30 mm) neck and/or small (<20 mm) aortic bifurcation. Case report We describe five patients with large aortic necks and/or small aortic bifurcations, which were treated by combining an AFX endoprosthesis with a Valiant Captiva endograft, and additional proximal endoanchors when deemed necessary. Initial technical success was 100%. Follow-up ranged from 228 to 875 days. One patient suffered a type 1A and 1B endoleak at 446 days follow-up, which were successfully treated by endovascular means. Conclusion Combining the AFX and Valiant Captiva endografts is an off-the-shelf solution for treatment of large diameter aortic necks and small aortic bifurcations in patients deemed unfit for open repair or declined for fenestrated endografts. Longer follow-up is required to assess the long-term safety with special focus on aortic neck dilation.

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